Comparison of the 1997 and 2003 American Diabetes Association Classification of Impaired Fasting Glucose Impact on Prevalence of Impaired Fasting Glucose, Coronary Heart Disease Risk Factors, and Coronary Heart Disease in a Community-Based Medical Practice

ObjectivesThe goals of this study were to assess the effect of the 2003 American Diabetes Association definition of impaired fasting glucose (IFG) on prevalence of IFG, coronary heart disease (CHD) risk factors, and CHD compared with the 1997 IFG definition.BackgroundAlthough IFG is viewed as increasing CHD risk, this association is unclear and has not been well studied after changing the IFG criterion, especially in a clinical practice setting.MethodsThis was a cross-sectional evaluation of 8,295 members (3,763 men and 4,532 women) of a community medical center who were between the ages of 30 and 69 years, without a history of diabetes mellitus, and who had available measurements of fasting plasma glucose and lipid concentrations within the past 2 years. The prevalence of IFG, CHD risk factors, and CHD with the 1997 and 2003 IFG definition was compared.ResultsThe prevalence of IFG increased from 8% to 35% with the 2003 criterion. Individuals with glucose of 100 to 109 mg/dl had lower prevalence of most CHD risk factors (hypertension, triglyceride ≥150 mg/dl, high-density lipoprotein cholesterol <40 mg/dl, meeting 2 components of the metabolic syndrome criteria, CHD risk ≥10% by Framingham score) compared with individuals with glucose 110 to 125 mg/dl. Individuals identified with the 2003 IFG definition did not have an increase in known CHD when adjusted for covariates (odds ratio 1.4 [95% confidence interval (CI) 0.7 to 2.3] vs. 3.2 [95% CI 1.8 to 5.9]).ConclusionsOne-third of the population has IFG with the 2003 definition, yet many of these individuals do not have increased prevalence of CHD risk factors or CHD

Insulin resistance:Impact on therapeutic developments in diabetes

Insulin resistance has a broad pathogenic impact affecting metabolic, cardio-renal and other disease areas. Extensive studies to dissect the mechanisms of insulin resistance have provided valuable insights to shape current clinical awareness and advance therapeutic practice. However, the development of direct interventions against insulin resistance has been hindered by its complex and highly variable presentations, especially in type 2 diabetes. Among glucose-lowering agents, metformin and thiazolidinediones provide cellular actions that counter some effects of insulin resistance: reduced glucotoxicity and weight-lowering with antidiabetic therapies also improve insulin action, except that endogenously- or exogenously-created hyperinsulinaemia may partially compromise these benefits. Increasing awareness of the pervasiveness and damaging ramifications of insulin resistance heightens the need for more specifically targeted and more effective therapies

Comparison of two surrogate estimates of insulin resistance to predict cardiovascular disease in apparently healthy individuals

Background and aims: Insulin resistance is associated with a cluster of abnormalities that increase cardiovascular disease (CVD). Several indices have been proposed to identify individuals who are insulin resistant, and thereby at increased CVD risk. The aim of this study was to compare the abilities of 3 indices to accomplish that goal: 1) plasma triglyceride × glucose index (TG × G); 2) plasma triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-C); and 3) Metabolic Syndrome (MetS). Methods and results: In a population sample of 723 individuals (486 women and 237 men, 50 ± 16 and 51 ± 16 years old, respectively), baseline demographic and metabolic variables known to increase CVD risk and incident CVD were compared among individuals defined as high vs. low risk by: TG × G; TG/HDL-C; or MetS. CVD risk profiles appeared comparable in high risk subjects, irrespective of criteria. Crude incidence of CVD events was increased in high risk subjects: 12.2 vs. 5.3% subjects/10 years, p = 0.005 defined by TG/HDL-C; 13.4 vs. 5.3% subjects/10 years, p = 0.002 defined by TG × G; and 13.4% vs. 4.5% of subjects/10 years, p < 0.001 in subjects with the MetS. The area under the ROC curves to predict CVD were similar, 0.66 vs. 0.67 for TG/HDL-C and TG × G, respectively. However, when adjusted by age, sex and multiple covariates, hazard ratios for incident CVD were significantly increased in high risk patients classified by either TG/HDL-C ratio (2.18, p = 0.021) or MetS (1.93, p = 0.037), but not by TG × G index (1.72, p = 0.087). Conclusion: Although the 3 indices identify CVD risk comparably, the TG × G index seems somewhat less effective at predicting CVD.Facultad de Ciencias Médica

Model institutional infrastructures for recycling of photovoltaic modules

This paper describes model approaches to designing an institutional infrastructure for the recycling of decommissioned photovoltaic modules; more detailed discussion of the information presented in this paper is contained in Reaven et al., (1996)[1]. The alternative approaches are based on experiences in other industries, with other products and materials. In the aluminum, scrap iron, and container glass industries, where recycling is a long-standing, even venerable practice, predominantly private, fully articulated institutional infrastructures exist. Nevertheless, even in these industries, arrangements are constantly evolving in response to regulatory changes, competition, and new technological developments. Institutional infrastructures are less settled for younger large- scale recycling industries that target components of the municipal solid waste (MSW) stream, such as cardboard and newspaper, polyethylene terephthalate (PET) and high-density polyethylene (HDPE) plastics, and textiles. In these industries the economics, markets, and technologies are rapidly changing. Finally, many other industries are developing projects to ensure that their products are recycled (and recyclable) e.g., computers, non-automotive batteries, communications equipment, motor and lubrication oil and oil filters, fluorescent lighting fixtures, automotive plastics and shredder residues, and bulk industrial chemical wastes. The lack of an an adequate recycling infrastructure, attractive end-markets, and clear the economic incentives, can be formidable impediments to a self- sustaining recycling system

β- and α-Cell Dysfunction in Subjects Developing Impaired Glucose Tolerance: Outcome of a 12-Year Prospective Study in Postmenopausal Caucasian Women

OBJECTIVE— This study assessed insulin and glucagon secretion in relation to insulin sensitivity in Caucasian women who develop impaired glucose tolerance (IGT) versus those who maintain normal glucose tolerance (NGT) over a 12-year period